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JAMA Clinical Evidence Synopsis |

β-Blockers as Initial Therapy for Hypertension

Charles S. Wiysonge, MD, PhD1; Lionel H. Opie, MD, DPhil2
[+] Author Affiliations
1Centre for Evidence-Based Health Care, Stellenbosch University, Cape Town, South Africa
2Hatter Institute for Cardiovascular Research in Africa, University of Cape Town Medical School, Cape Town, South Africa
JAMA. 2013;310(17):1851-1852. doi:10.1001/jama.2013.277510.
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Clinical Question  Are β-blockers associated with lower rates of all-cause mortality and cardiovascular events when used as initial treatment in individuals with hypertension compared with placebo, no treatment, or other drugs?

Bottom Line  Initial therapy of hypertension with β-blockers is not associated with reduced all-cause mortality but is associated with modest reductions in cardiovascular events compared with placebo or no treatment. Calcium channel blockers and renin-angiotensin system inhibitors are associated with greater reductions in cardiovascular event rates than β-blockers. This evidence derives from trials of traditional β-blockers (eg, atenolol and propranolol), because there are currently no mortality and cardiovascular event data on the new vasodilating β-blockers (eg, carvedilol and nebivolol).

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Associations of β-Blocker Therapy With All-Cause Mortality Among Patients With Hypertension vs Placebo, No Treatment, and Other Drugs

Source: Data have been adapted with permission from Wiley.2

The size of the data markers is proportional to the number of participants and deaths.

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